Safety Connections Detecting and assessing suicidal ideation and risk in secondary care. Dr Jane Hutton & Anna Simpson

Transcription

1 Safety Connections 2017 Detecting and assessing suicidal ideation and risk in secondary care Dr Jane Hutton & Anna Simpson Contact us: Find us: Follow

2 Contents 1. Suicidality 2. Integrating mental and physical healthcare 3. Identifying suicidal ideation and assessing risk 4. Training and education for healthcare professional

3 The Problem Rates of suicide are rising after years of decline Average 13 people commit suicide per day in England Suicide is the biggest killer of men under the age of 50 and the leading cause of death in young men Suicide is the 2 nd leading cause of maternal death

4 Suicide prevention major policy objective National ambition to reduce suicide rates by 10% by 2020/21

5 Suicidality risk factors Previous suicide attempt(s) () History of mental disorders, particularly clinical depression Physical illness History of alcohol and substance abuse Feelings of hopelessness Isolation, a feeling of being cut off from other people Barriers to accessing mental health treatment Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal thoughts

6 Suicidality risk factors Previous suicide attempt(s) () History of mental disorders, particularly clinical depression Physical illness History of alcohol and substance abuse Feelings of hopelessness Isolation, a feeling of being cut off from other people Barriers to accessing mental health treatment Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal thoughts

7 Mental/physical health comorbidity

8 Integrating gmental and physical health is a major policy objective

9 The IMPARTS package supports implementation of evidence based guidelines Informatics Routine collection of patientreported outcomes with advice on care & referral Care pathways Development of mental health care pathways for patients identified via screening Training Training in mental health skills with ongoing supervision from a mental health specialist Self-help Portfolio of bespoke self-help materials, tailored to specific physical conditions Research Research database Development and evaluation of new interventions

10 The IMPARTS screening interface A web-based screening interface to improve detection and management common mental health problems in a diverse range of physically ill populations - patient-reported mental and physical health outcome measurement - embedded in routine clinical practice - informs patient care and referral in real-time > IMPARTS flags up any psychological issues to address prior to consultation

11 Bespoke battery of questionnaires (100+) Physical health Mental health Health behaviours Psychological l factors Frequency of symptoms Severity of symptoms Impact of symptoms Depression Anxiety Distress PTSD Adherence Smoking Alcohol/substance use Sleep Self efficacy Locus of control Catastrophising Fear avoidance

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16 Implementation Current 45 clinics: King s, Guy s and St Thomas hospitals 17,844 individual id patients screened 33,172 screening contacts In progress 11 new clinics SLaM Physical Health Plan pilot Future strategic development Renal Breathlessness Haematology Institute ED scoping exercise

17 Referral pathway Suicidal ideation AND severe depression (PHQ-9 score=20-27) Urgent referral to liaison psychiatry Suicidal ideation OR severe depression (PHQ-9 score=20-27) Referral to liaison psychiatry Mild to moderately severe depression (PHQ-9=<19) WITH complex interaction with medical problem Mild to moderately severe depression (PHQ-9=<19) WITHOUT complex interaction with medical problem Referral to clinical i l psychology Referral to IAPT

18 Staff Training Individual services General Assessing & responding to depression & suicide risk Identify training needs Bespoke training delivery General Motivational interviewing techniques for healthier living Specific Hand therapy: Motivation, depression & fear of movement 17 Review Specific Hand therapy: Trauma & predictors of PTSD

19 Staff Training: Mental health skills for non mental health professionals Day1: The Anxious/Distressed/ Depressed Patient Day 2: The Confused/Agitated Patient Day 3: The Substance Misusing Patient Day 4: Managing Conflict Day 5: The Patient with Medically Unexplained Symptoms 5 day teaching course, MSc Level 7, 15 credits p// p g/ g/ 18

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22 Feedback Video Limb reconstruction ction patient work/mind and

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25 Risk assessment guide for patients who screen positive for suicidal ideation Step 1: Check the patient s response to PHQ 9 Item 9 Have you been having these thoughts in the last 2 weeks? Yes No Make a referral to IAPT/GP Step 2: Assess hopelessness Do you feel life is not worth living? Are you feeling hopeless about the present or future? Assess suicidal ideation Have you had any thoughts about taking your own life? Yes or ambivalent Step 3: Assess suicidal plans Have you made plans for how you would do it? Do you have the means to carry them out? Have you considered what might stop you? Ak Ask about previous attempts t Have you ever tried to end your life before? Ask about recent life stressors (e.g. worsening physical health, bereavement etc) What has been happening recently..? Ak Ask about mental tlhealth problems Have you ever suffered with a mental health problem such as depression? Assess social support/ safety Is there anyone you can confide in or turn to for some support? No Make a referral to IAPT/GP Action Points: Can you make a commitment that you will keep yourself safe until [offer another appointment within the next week or so]? In the meantime discuss with liaison py psychiatry. y Think with the patient about ways he/she might be able to keep safe e.g. being with people, calling a friend if feeling low. Advise patient to attend A&E if feeling in crisis. If you have immediate concerns about safety and the patient presents with any combination of: Detailed Suicidal Plan AND/OR Serious Previous Attempt AND/OR Mental Health Problem AND/OR Social isolation 1) Contact liaison Psychiatry for discussion of patient and advice OR 2) Take the patient to A&E, where they will be assessed. If patient has concerns about visiting A&E, attempt to address these concerns. If they fear psychiatric admission psychiatric admission, inform them community care is provided wherever possible. If patient still refuses, allow them to go home but phone their GP to update.

26 Education and training IMPARTS teaching course Video - Assessment of suicidal risk

27 The Team Prof Matthew Hotopf, Project Director Dr Jane Hutton, Htt Consultant t Clii Clinical l Psychologist it Dr Lauren Rayner, Project Lead Anna Simpson, Project Coordinator Sanchika Campbell, Research Worker Chris Fassnidge, g, Research Worker Simone Jayakumar, Research Worker us on: imparts@kcl.ac.uk Visit us at: imparts Follow us: